psychosis

Question 1

What is psychosis

Answer 1

clinical state of mind characterized by loss of contact with reality
symptoms
perceptual disturbances:
delusion, hallucinations

social or occupation dysfunction
negative symptoms alogia, blunting effect, avolition

Question 2

delirium with acute confusion and aggression

Answer 2

impaired awareness, confusion, disorientation
always look for cause:
Drugs
Infection
Metabolic
Trauma
Oxygen
Psychological

Question 3

pathogenesis of psychosis

Answer 3

dopamine hypothesis of schizophrenia - excessive dopaminergic activity

Question 4

cause of psychosis

Answer 4

Functional psychosis
Schizophrenia
Bipolar mood disorder

Psychotic disorders due to medical conditions
Medical conditions e.g. epilepsy, Alzheimer’s dementia, HIV, neurosyphilis

Drugs
Illicit drugs –cannabis, mandrax, cocaine, amphetamines
Prescription drugs- steroids, antiparkinsonism drugs, atropine

Other- e.g. postpartum psychosis

Question 5

neuroleptics

Answer 5

Classical neuroleptics 
Dopamine 2 receptor antagonists
Tendency to cause extrapyramidal side effects
Atypical neuroleptics 
D2 & D3 receptor antagonists
D2 & serotonin receptor antagonist

Question 6

what are the indications of neuroleptics

Answer 6

schizo
mania
organic psychosis
others 
nausea, vomiting 
anaesthesia 
intractable hiccups 
tourette's syndrome- repetitive movements that cannot be controlled

Question 7

route of administration

Answer 7

oral

injectables- short (acute management) or long acting

Question 8

adverse effects of antipsychotics

Answer 8

typical -inhibit serotonin and histamine receptors instead of d2 and 1
atypical- inhibit serotonin and alpha adrenergic instead of d2 only

Question 9

causes of treatment failure

Answer 9

under dosing
malabsorption
wrong diagnoses
non compliace

Question 10

which group is contraindicated

Answer 10

pregnancy or lactation- drugs can cross the placenta
phenothiazines excreted in breast milk
children
elderly- more susceptible to CVS and anti-cholinergic side effects
hepatic diseases -dose adjustment

Question 11

phenothiazine- chlorpromazine adverse effects

Answer 11

Adverse effects: EPSEs, sedation, postural hypotension, anticholinergic side effects, epileptogenic, photosensitivity ,jaundice, agranulocytosis

Question 12

acute dystonic reaction

Answer 12

spasm of muscles of the tongue, neck, face and back

stop neuroleptic and give biperiden
give benzodiazepine if necessary

Question 13

parkinsonism

Answer 13

tremor, bradykinesia, rigidity

give anticholinergics 50-150 mg

Question 14

Akathisia

Answer 14

motor restlessness vs anxiety, caused by excess dopamine
treatment reduce dose and add anticholinergic
change to typical antipsychotics if there are complications
complications:
dyskinesia

Question 15

Neuroleptic malignant syndrome

Answer 15

caused by dopamine blockade in hypothalamus
present with:
Hyperpyrexia
Sweating
Unstable blood pressure
Changes in LOC (stupor or catatonia like state)
Muscle rigidity- lead overactive muscles

Question 16

side effects of atypical neuroleptics

Answer 16

associated with QT prolongation
less EPSE
weight gain
prolactin effects

Question 17

chlorpromazine contraindications and drug interactions

Answer 17

Contraindicated in coma, severe mental depression, severe liver impairment, significant cardiac disorders, glaucoma, bone marrow depression

drug interactions with
anticholinergics, antiepileptics, antihypertensives, antiparkinsonism drugs, CNS depressants , enzyme inducers

Question 18

haloperidol adverse effects,drug interaction and contraindications

Answer 18

Contraindicated in Parkinson’s and pt with history of EPSEs from neuroleptics

Drug interaction
Lithium –neurotoxicity
As with other antipsychotic drugs

Adverse effects: less anticholinergic, hypotensive, least epileptogenic BUT increased risk of EPSEs

Question 19

clozapine- dibenzodiazepine

Answer 19

used for resistant 
psychosis 
atypical neuroleptic 
Adverse effects:
Weight gain, agranuloctosis and neutropenia, sedation, postural hypotension, anticholinergic s/e.LESS EPSEs

Contraindicated in history of drug induced agranulocytosis

Question 20

difference among antipsychotic drugs

Answer 20

low threshold in lowering seizure
tendency to cause metabolic and endocrine effects
tendency to cause cardiac toxicity (arrhythmias, QT prolongation)

Question 21

effect of antipsychotics on different receptors

Answer 21

Muscarinic receptors-
anticholinergic-urinary retention, blurred vision, orthostatic hypotension, erectile dysfunction
Histamine receptors- sedation, antiemetic
Alpha adrenergic receptor- orthostatic hypotension
Serotonin receptors- psuedodepression